Health and Welfare Program Area Summary

Transcription

1 Overview The Health and Welfare program area consists of five agencies Agency 67, Department of Family Services (DFS), Agency 68, Department of Administration for Human Services (DAHS), Agency 71, Health Department, Agency 73, Office to Prevent and End Homelessness (OPEH), and Agency 79, Department of Neighborhood and Community Services (NCS). Their collective mission is to protect the vulnerable, help people and communities realize and strengthen their capacity for selfsufficiency, and ensure good outcomes through prevention and early intervention. In addition to these five agencies, there are others that comprise the Human Services System. They are Agency 81, Juvenile and Domestic Relations District Court (Public Safety Program Area), Agency 38, Department of Housing and Community Development (Community Development Program Area), as well as Fund 40040, Fairfax Community Services Board (CSB) found in Volume 2 of the FY 2017 Adopted Budget Plan. Human Services functions are also addressed in other funds such as Fund 50000, Federal State Grants; Fund 10020, Consolidated Community Funding Pool; and Fund 30080, Commercial Revitalization Program. The Human Services System works to communicate the relationships among public and community based efforts to achieve shared goals for individuals, families, and communities. The Human Services System continues to focus on cross cutting strategic initiatives, the broad community outcomes they support and the systemʹs progress toward achieving them. A detailed narrative for each agency within the Health and Welfare program area can be found on subsequent Volume 1 pages of the FY 2017 Adopted Budget Plan. The community outcome areas are summarized below: People are able to meet basic needs for themselves and their families Children thrive and youth successfully transition to adulthood Seniors and persons with disabilities live with maximum dignity and independence People and communities are healthy People have access to high quality appropriate services at the right time The Human Services System maximizes the communityʹs investment in human services The Department of Family Services is the largest of the County s human services agencies, with employees deployed in regional offices and community sites throughout the County. DFS programs and services are provided through its five divisions: Self Sufficiency; Adult and Aging; Children, Youth and Families; Child Care; and Cross Division Services, as well as the Office for Women and Domestic and Sexual Violence Services; System of Care which includes behavioral health services for youth and the Children s Services Act (CSA); and Disability Services Planning and Development. The department partners with community groups, faith based organizations, businesses and other public organizations to meet changing community needs. DFS is critical in the County s effort to help residents negatively impacted by the weak economy. A continued uncertain economic environment means that many individuals are still seeking help from public assistance. Public assistance caseloads have increased by more than 84 percent since FY DFS maximizes the use of grant funding to support many different types of programs and services. Grant funding primarily supports employment services, services targeting the aging population, and services for children. In FY 2017, the department anticipates leveraging $31.2 million in non County resources to provide $35.0 million in services through grants.

2 DAHS serves the community with quality administrative and management services. DAHS provides administrative, consultative and management services to the Countyʹs human services departments and programs. The human services system directly serves over 100,000 individuals annually through the provision of social services, behavioral and primary health care, juvenile justice, affordable housing, and recreation services. Human services programs offered in the County affect almost everyone in the community. DAHS focuses on enhancing cross system coordination of business functions and identifying continuous process improvement opportunities to ensure both efficient and effective professional administrative services in the business areas of Financial Management, Human Resources, Contracts and Procurement Management, and Physical Resources. The County s human services system is very large, with approximately $470 million in expenditures and approximately 4,000 merit employees, while billing and collecting more than $170 million in revenues and reimbursements. Approximately 58,700 payments for goods and services are processed annually. The value of contracts handled by DAHS is approximately $157 million for contracted services offered through more than 1,100 contractual agreements. DAHS provides services and support to human services facilities by coordinating maintenance and space planning of facilities including seven emergency shelters, 120 office and service delivery sites, and oversees approximately 240 residential program sites serving consumers throughout the County. DAHS also provides residential lease management and federally required residential property services, emergency response planning at seven co located facilities, safety and security service coordination, and oversight of the department s Business Continuity planning as well as human services information technology, strategic planning, and project management for cross agency technology initiatives. The Health Department (FCHD) has five core functions: preventing epidemics and the spread of disease; protecting the public against environmental hazards; promoting and encouraging healthy behaviors; assuring the quality and accessibility of health services; and responding to disasters and assisting communities in recovery. These functions are the community facing elements of the 10 Essential Public Health Services (EPHS), which define public health and serve as the framework for quality and performance improvement initiatives nationwide. In FY 2015, the FCHD completed the progress report for year one of its Strategic Plan for , which outlines goals and objectives to strengthen the department s capacity to deliver the 10 EPHS. The department s strategic plan brings with it challenges (securing and retaining resources to address ongoing activities that are critical to the community) and opportunities (leveraging community assets and other resources to enable the department to reorient towards population based prevention programs that focus on disease prevention and health promotion). While progress has been made in developing internal resources, building a strong public health infrastructure remains central to effective delivery of the 10 EPHS and to adequately address the public health challenges of today and the future. This means investing in the workforce so that employees are prepared for the changing role of public health; continuing to build strategic partnerships to address the health needs of the community and the root causes of health inequities; communicating effectively with colleagues, partners, and customers; monitoring and evaluating community health data to understand the health status of the community; and leveraging technology to increase efficiency in service delivery. Enhancing capacity in these areas will improve the ability of the FCHD to anticipate emerging public health issues and to proactively address them. OPEH is tasked with providing day to day oversight and management of the Ten Year Plan to Prevent and End Homelessness in the Fairfax community, and the management, oversight and operation of many of the homeless services provided by the County. The Ten Year Plan to Prevent and End Homelessness (The Plan) was developed around the Housing First Concept which requires that individuals

3 and families experiencing homelessness be placed in longer term residences as quickly as possible. In doing so, the support provided through social services and other interventions will achieve greater outcomes. The Plan is centered on creating a strong community partnership between government, business, faith and non profit communities. OPEH is also responsible for the management and operation of the following homeless services: emergency homeless prevention funds, Housing Opportunities Support Teams (HOST), emergency shelters, motel placements, transitional housing, supportive permanent housing/home ownership, housing first housing for chronically homeless individuals, and hypothermia prevention. There are still many homeless support services that are provided by other County agencies such as the Department of Housing and Community Development, the Fairfax Community Services Board, the Department of Family Services and the Health Department. OPEH collaborates closely with these agencies and with nonprofits to provide coordinated and effective homeless services in the community. The Department of Neighborhood and Community Services has three primary functions. The first is to serve the entire human services system through the use of data driven decisions to identify service gaps, by initiating efforts to track and improve human service outcomes, and demonstrating efficiencies in service delivery. Capacity building within Human Services is coordinated and led by the department, but also involves all stakeholders both within County government and the community as a whole. The second function is to deliver information and connect people, community organizations, and human service professionals to resources and services provided within the department, and more broadly throughout the community. Access to services is provided across the spectrum of needs (including transportation to services) and in some cases, includes the provision of direct emergency assistance. Finally, the department promotes the well being of children, youth, families and communities. NCS supports partners and the community by facilitating skill development and the leveraging of resources that can resolve self identified challenges. In partnership with various public private community organizations, neighborhoods, businesses and other County agencies, the department also uses prevention and community building approaches to provide direct services for residents and communities throughout the County. Strategic Direction As part of the countywide focus on developing strategic plans, the agencies in this program area have each developed mission, vision and value statements; performed environmental scans; and defined strategies for achieving their missions. These strategic plans are linked to the overall County core purpose and vision elements. Common themes among the agencies in this program area include: Self sufficiency of residents to address basic needs Prevention Early intervention Access to services Partnerships with community organizations to achieve mutual goals Building capacity in the community to address human service needs Cultural and language diversity Emerging threats, such as communicable diseases and bioterrorism Building a high performing and diverse workforce Maximizing local, state and federal resources COUNTY CORE PURPOSE To protect and enrich the quality of life for the people, neighborhoods, and diverse communities of by: Maintaining Safe and Caring Communities Building Livable Spaces Practicing Environmental Stewardship Connecting People and Places Creating a Culture of Engagement Maintaining Healthy Economies Exercising Corporate Stewardship

4 A number of demographic, economic, social, and governance trends affect this program area. With regard to demographics, the tremendous growth in population has an impact on the services provided by these agencies. has experienced double digit population growth in each decade since the 1970s. s population mirrors the national trend in that it is growing older. The County s population is increasing in number, age and diversity. NCS estimates that the 2015 population of older adults (age 65 and older) in was 135,987. It is expected that there will be 192,325 by Additionally, the County is growing more diverse. In 1990, more than 13 percent of older adults spoke a language other than English at home, and by 2013 the American Community Survey estimated that the number had grown to approximately 26.7 percent. From 1980 to 2010, the percentage of minorities in the older adult population increased from 8.1 percent to 29.3 percent. In recent years, Human Services agencies have played a crucial role in responding to a number of public health and safety concerns such as the threat of chemical, biological or radiological attacks, as well as the occurrence of norovirus, Ebola, Zika virus, food borne illnesses, measles, seasonal flu outbreaks and pandemics, the prevalence of tuberculosis in the community, the increased number of contaminated food product recalls, and the increase in the number of communicable disease illnesses. Domestic violence likewise presents a growing problem, as the demand for counseling services continues to increase; incidents of domestic violence in the community surge; and increasing numbers of families are turned away from Artemis House, the County s 24 hour emergency shelter for victims of domestic violence, due to a space shortage. In addition to growing demand for services, the demographic trends and economic status variation within the County pose further challenges to dealing with the wide range of Human Services related matters in the community. Addressing the many issues facing Human Services has resulted in the development of a shared governance model for how residents are given a voice, how decisions are made on matters of public concern and how partnerships are formed to develop solutions to community challenges. Building capacity is essential if is to address the many needs in this area. Program Area Summary by Category Category FY 2015 Actual FY 2016 Adopted FY 2016 Revised FY 2017 Advertised FY 2017 Adopted FUNDING Expenditures: Personnel Services $149,564,807 $158,616,323 $160,489,132 $166,092,136 $167,153,798 Operating Expenses 145,129, ,796, ,986, ,887, ,977,040 Capital Equipment 319, , Subtotal $295,014,011 $313,412,608 $323,191,652 $324,979,676 $326,130,838 Less: Recovered Costs ($8,740,397) ($9,424,400) ($9,424,400) ($9,504,400) ($9,504,400) Total Expenditures $286,273,614 $303,988,208 $313,767,252 $315,475,276 $316,626,438 Income $130,681,260 $130,354,145 $131,915,002 $133,066,695 $134,634,582 NET COST TO THE COUNTY $155,592,354 $173,634,063 $181,852,250 $182,408,581 $181,991,856 AUTHORIZED POSITIONS/FULL-TIME EQUIVALENT (FTE) Regular 2499 / / / / /

5 Program Area Summary by Agency Category FY 2015 Actual FY 2016 Adopted FY 2016 Revised FY 2017 Advertised FY 2017 Adopted Department of Family Services $183,351,821 $195,671,254 $199,771,770 $200,960,146 $202,003,003 Department of Administration for Human 12,368,239 12,995,921 13,091,282 13,490,180 13,490,180 Services Health Department 51,873,700 55,083,029 58,754,832 58,507,785 58,526,590 Office to Prevent and End Homelessness 10,914,595 12,141,549 13,439,031 12,971,017 12,971,017 Department of Neighborhood and 27,765,259 28,096,455 28,710,337 29,546,148 29,635,648 Community Services Total Expenditures $286,273,614 $303,988,208 $313,767,252 $315,475,276 $316,626,438 Budget Trends The agencies in the Health and Welfare program area protect the vulnerable, help people and communities realize and strengthen their capacity for self sufficiency, and ensure good outcomes through prevention and early intervention. For FY 2017, the total funding level of $316,626,438 for the Health and Welfare program area represents 21.5 percent of the total General Fund direct expenditures of $1,474,556,275. This total reflects a net increase of $12,638,230 or 4.2 percent over the FY 2016 Adopted Budget Plan total of $303,988,208. The increase is attributed to $5.3 million supporting a 1.33 percent market rate adjustment and performance based and longevity increases for employees in FY 2017, effective July 2016; $3.3 million for contract rate increases for the providers of mandated and non mandated services; $1.5 million to address public assistance caseloads; $1.1 million to increase capacity of the School Age Child Care (SACC) program; $0.5 million related to personnel adjustments as a result of pay scale changes for Public Health Doctors; $0.4 million for School Health requirements for medically fragile students; $0.4 million to continue and expand Opportunity Neighborhoods programming in the County; and $0.5 million in other miscellaneous adjustments. These increases are offset by a decrease of $0.4 million due to programmatic changes within the Senior+ program in NCS and anticipated requirements in fuel charges and the Adoption Subsidy program in DFS. A detailed narrative for each agency within the Health and Welfare Program Area can be found on subsequent Volume 1 pages of the FY 2017 Adopted Budget Plan. The Health and Welfare program area includes 2,539/2, FTE positions, an increase of 1/1.0 FTE position from the FY 2016 Revised Budget Plan. There are no new positions included in the FY 2017 Adopted Budget Plan; however, there is 1/1.0 FTE position included for DAHS, reflecting an internal realignment from Fund 40040, Fairfax Community Services Board, resulting in no net increase in positions to the County. The following charts illustrate funding and position trends for the agencies in this program area compared to countywide expenditure and position trends.

6 Trends in Expenditures and Positions It should be noted that, as part of the FY 2011 Adopted Budget Plan, the Department of Community and Recreation Services was consolidated with Systems Management for Human Services to form the Department of Neighborhood and Community Services. As a result, expenditures and positions increased in the Health and Welfare Program Area, where the Department of Neighborhood and Community Services is displayed and decreased in the Parks and Libraries Program Area, where the Department of Community and Recreation Services was shown.

7 FY 2017 Expenditures and Positions by Agency

8 Benchmarking Comparative performance information for the Health and Welfare program area comes from a variety of sources. This is one of the richer program areas for benchmarking due to the wide variety of programs and statistics that are collected. Data included for this program area was obtained from several sources, including the Commonwealth of Virginia s Auditor of Public Accounts (APA), the Virginia Department of Health and the Virginia Department of Social Services. The APA collects financial data annually from all Virginia jurisdictions. FY 2014 data represents the latest data available. As seen below, s cost per capita for Health and Welfare indicates the high level of local support for these programs and reflects the County s increasing urbanization that brings its own challenges in terms of human service needs. Data provided by the Virginia Department of Health is included to show how compares to other large jurisdictions in the state, as well as the statewide average in the areas of teen pregnancy rate, low birth weight and infant mortality. The following graphs compare to other large jurisdictions in the Commonwealth and indicate a fairly constant high level of performance. Some data refer to the Virginia Initiative for Employment not Welfare (VIEW), a program which supports the efforts of families receiving Temporary Assistance for Needy Families (TANF) to achieve independence through employment. VIEW focuses on the participantsʹ strengths and provides services to help them overcome job related challenges, as well as personal, medical and family challenges that affect employment. The Department of Family Services (DFS) administers benefits under the federal TANF program, which provides temporary cash assistance to low income families with children. Parents who receive this assistance, and are able to work, are required to participate in the VIEW program. The VIEW program offers parents the assistance and resources needed to find and keep a job. Some data is also taken from the 2015 Community Health Status Indicators (CHSI), produced by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. CHSI 2015 is an interactive web application that produces health profiles for all 3,143 counties in the United States. Each profile includes key indicators of health outcomes, which describe the population health status of a county and factors that have the potential to influence health outcomes, such as health care access and quality, health behaviors, social factors and the physical environment. On the CHSI Website, data can be filtered by state and county: wwwn.cdc.gov/communityhealth/home

9 Health and Welfare Cost Per Capita Stafford County Chesapeake Spotsylvania County Fairfax City Norfolk Newport News Alexandria $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $0 $900 Source: Commonwealth of Virginia Auditor of Public Accounts; FY 2014 Comparative Report of Local Government Revenues and Expenditures, Exhibit C: see Data for the City of Richmond was not available. Female Life Expectancy Montgomery County, MD City of Alexandria Fairfax City U.S. Median Prince George's County, MD Data year: Life Expectancy estimates were provided by the Institute for Health Metrics and Evaluation (IMHE): 2015 Community Health Status Indicators (CHSI): The U.S. Centers for Disease Control and Prevention: wwwn.cdc.gov/communityhealth/profile/currentprofile/va/fairfax/

10 Male Life Expectancy Montgomery County, MD City of Alexandria Fairfax City U.S. Median Prince George's County, MD Source: Data year: Life Expectancy estimates were provided by the Institute for Health Metrics and Evaluation (IMHE): 2015 Community Health Status Indicators (CHSI): wwwn.cdc.gov/communityhealth/profile/currentprofile/va/fairfax/ Percent of Adults 20 Years and Older With Body Mass Index (BMI) >=30.0 kg/m² Calculated from Self-Reported Weight and Height Montgomery County, MD 16.9% 17.2% 17.7% Fairfax City 20.4% 21.2% 23.0% 24.4% 26.4% 27.0% U.S. Median Prince George's County, MD 30.4% 32.6% 0% 40% Percent of Adults 20 years and over who have a body mass index (BMI) >=30.0 kg/m² calculated from self reported weight and height. Data Years: 2006 to Community Health Status Indicators (CHSI): wwwn.cdc.gov/communityhealth/profile/currentprofile/va/fairfax/

11 Percent of Adults (20 years and older) Living with Diagnosed Diabetes Fairfax City City of Alexandria Montgomery County, MD 3.8% 4.3% 4.9% 5.4% 5.6% 5.8% 6.2% U.S. Median 7.6% 7.7% 7.9% 8.1% 9.2% Prince George's County, MD 10.4% 0% 12% Source: Data taken between 2005 and Cited by 2015 Community Health Status Indicators (CHSI): by the U.S. Centers for Disease Control and Prevention. Prevalence of Alzheimer's Disease and Dementia Among Medicare Fee-For-Service Beneficiaries Fairfax City U.S. Median Prince George's County, MD City of Alexandria Montgomery County, MD 9.8% 9.8% 10.0% 10.2% 10.3% 10.9% 11.0% 11.2% 11.3% 11.8% 12.2% 12.4% 15.2% 0% 20% Data Years: Community Health Status Indicators (CHSI): wwwn.cdc.gov/communityhealth/profile/currentprofile/va/fairfax/ Chronic conditions for adults age 65 and older, were identified through Medicare administrative claims. Medicare beneficiaries were considered to have a chronic condition if the Center of Medicare and Medicaid Services (CMS) administrative data had a claim indicating that they were receiving a service or treatment for the specific condition.

12 Teen Pregnancy Rates Per 1,000 Females (15-17 years old) City of Fairfax City of City of Alexandria City of Norfolk 28.9 City of Richmond Source: Virginia Department of Health 2013 Health Statistics: City/County Profiles - Births, pregnancies, infant/fetal deaths, induced terminations, leading causes of death, and population with health district and state comparisons: see Percent of Low Birthweight Babies 5.9% City of City of Alexandria City of Fairfax 6.6% 6.7% 7.0% 7.2% 7.2% 7.3% 7.6% 8.0% 8.0% 8.3% City of Richmond City of Norfolk 10.5% 10.7% 0% 12% Source: Virginia Department of Health 2013 Health Statistics: City/County Profiles Births, pregnancies, infant/fetal deaths, induced terminations, leading causes of death, and population with health district and state comparisons: see

13 Total Infant Deaths Per 1,000 Live Births 0.0 City of Fairfax 1.6 City of Alexandria City of City of Richmond 10.6 City of Norfolk Source: Virginia Department of Health 2013 Health Statistics: City/County Profiles Births, pregnancies, infant/fetal deaths, induced terminations, leading causes of death, and population with health district and state comparisons: see Rates of Child Abuse and Neglect Per 1,000 Children Alexandria City of Richmond Norfolk Source: Most recent data is for FY 2013.

14 Children in Foster Care - Rate Per 1,000 Youth (Ages 0-19) Stafford County Chesapeake Hampton Spotsylvania County Newport News Alexandria Norfolk Richmond City Source: number of children in foster care?loc=48&loct=5#ranking/5/any/true/36/any/ Population data Data represent a point in time count of the children in each locality in foster care on December 31, Average Time in Foster Care (in months) City of Richmond City of Alexandria Norfolk Source: Data represent a point in time count of the children in each locality in foster care on November 1, 2015

15 Virginia Initiative for Employment not Welfare (VIEW) / Temporary Assistance for Needy Families (TANF) Job Retention Rate Alexandria Norfolk Richmond City 86.05% 79.10% 78.67% 76.69% 75.44% 73.85% 73.50% 70.17% 69.83% 67.25% 64.49% 0% Retention Rate 100% Source: Virginia Department of Social Services Quality Management Performance Indicators - TANF /VIEWJob Retention - FY 2014 Virginia Initiative for Employment not Welfare (VIEW): Percent Employed in a Work Activity Norfolk Alexandria 57.07% 56.78% 54.65% 53.83% 53.38% 51.92% 51.25% 51.01% 50.65% 50.50% 0% Average Monthly Percent of Enrolled Participants in a Work Activity 75% Source: Virginia Department of Social Services - VSSS Performance Indicators-TANF/VIEW Percent Employed - FY 2014

16 Supplemental Nutrition Assistance Program (SNAP) Timeliness of Application Processing Norfolk Richmond City Alexandria 99.08% 98.97% 98.54% 98.23% 97.71% 97.67% 96.69% 95.73% 95.19% 92.88% 91.93% 0% Percent Timely 100% 112% Source: Virginia Department of Social Services: Quality Management Performance Indicators - SNAP Timeliness of Application Processing - FY 2014 Supplemental Nutrition Assistance Program (SNAP) Payment Accuracy (Error Rate) Norfolk 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.19% Alexandria 0.55% 0.60% 0.73% Richmond City 2.96% 0% Error Rate 4% Source: Virginia Department of Social Services: Quality Management Performance Indicators - SNAP Quality Assurance Payment Error Rate - FY 2014